42571 Per site
| 40000 | PERIODONTICS |
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| 42000 | PERIODONTAL SERVICES, SURGICAL |
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| 42500 | PERIODONTAL SURGERY, FLAPS, GRAFTS, SOFT TISSUE |
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| 42570 | Grafts, Connective Tissue, Pedicle With Free Graft For Root Coverage |
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| 42571 | Per site | $913.41 | $913.41 |